Intolerance to Enteral Nutrition

OVERVIEW

  • Intolerance to enteral nutrition is characterised by excessive aspirates (>500mL q6h),vomiting, abdominal distension, constipation or diarrhoea

CAUSES

Patient

  • GORD
  • hiatus hernia
  • gastroparesis/ileus
  • pseudo-obstruction
  • retroperitoneal haematoma/oedema
  • bowel injury
  • bowel ischaemia
  • shock
  • sepsis
  • pancreatitis
  • bowel obstruction
  • hyperglycemia
  • hypoxia / ischemia
  • trauma
  • burns

Mechanical

  • NGT not placed in stomach
  • kinking
  • blockage

Drugs

  • opioids
  • sedation
  • no prokinetics
  • hyperosmolar formulas

ASSESSMENT

History

  • sedation/analgesia: hold?
  • history of symptoms
  • discussion with surgeon
  • search for sepsis, pancreatitis, MI, GI pathology, cause of shock

Examination

  • to find above pathologies

Investigations

  • AXR
  • CXR (erect)
  • CT abdomen

MANAGEMENT

General approach

  • rule out bowel obstruction
  • minimize drugs causing gastroparesis or ileus
  • correct electrolytes
  • start at low volumes with steady increases until goal rate achieved
  • prokinetics
  • consider NJ feeding
  • TPN

Approach to gastric residual volumes >500mL q6h


References and Links

LITFL

Journal articles

  • Deane A, Chapman MJ, Fraser RJ, Bryant LK, Burgstad C, Nguyen NQ. Mechanisms underlying feed intolerance in the critically ill: implications for treatment. World J Gastroenterol. 2007 Aug 7;13(29):3909-17. PMID: 17663503.

CCC 700 6

Critical Care

Compendium

2 Comments

  1. I have been searching for help. My 36 year old son was born with cystic fibrosis. He had his first double lung transplant at 15. He had his second double lung transplant at 25. He under went a third double lung transplant at 35 this past September 13th 2020.
    He has been in ICU at Toronto General Hospital for 5 months with many challenges. He has a trach, is on dialysis yet slowly he is getting stronger. The biggest problem has been feeding intolerance. Since October he has battled gas, bloating, diareaha, and is still not able feeds. Any recommendation would be greatly appreciated.

    • Hi Tanis, sounds like you and your son have had a really hard time of it. His situation sounds incredibly complicated and it’s not our place to offer specific advice here. I’m sure the team in Toronto would be looking at the usual options and it’s best to take it up with them.

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